Toxic epidermal necrolysis (TEN) is a critical life-threating condition developing as the total detachment of epidermidis and characterized by severe pathological reactions of all body systems. The current article describes two cases of TEN with similar clinical and laboratory signs. In one case the diagnosis of TEN was subsequently refused.The objective: analysis of methods of clinical and differential diagnostics of conditions accompanied with massive epidermidis detachment in ICU patients.Results. The immunomorphological evaluation of skin specimen obtained from the patient with a torpid form of TEN showed linear IgG fixation in the intercellular space of stratum basale, stratum spinosum and stratum granulosum and C3 fixation in the intercellular space of stratum basale.Conclusion. The complex of anamnesis data and pathomorphological evaluation of skin are crucial for the diagnosis and treatment of patients with atypical TEN.

The results of a study on the effectiveness of photodynamic therapy with a photosensitizer fotoditazin and cryotherapy for actinic keratosis are represented in the article. The study included 80 patients with 215 lesions, among them erythematous form of actinic keratosis was diagnosed in 151 (70.2%) cases, hyperkeratotic form – in 46 (21.4%) cases, a pigmented form – in 12 (5.6%) and an atypical variant of the disease – in 6 (2.8%) cases. According to histological type the distribution of tumor was as follows: 19 (54.3%) cases were diagnosed as hypertrophic type, 6 (17.1%) – atrophic, 8 (22.9%) – bowenoid and 2 (5.7% ) – pigmented type. Patients from the study group received one session of photodynamic therapy using laser unit "LAMI" (662 nm) after 2 hours of application of fotoditazin 0.5% gel at dose of 0,2-0,3 ml per 1 cm2 of actinic keratosis focus with the following parameters: the energy density of the laser radiation – 200 J/cm2, power density – 0.14–0.48 W/cm2. In the control group patients underwent cryotherapy with liquid nitrogen with an exposure of 30-60 sec. The comparative analysis of the immediate results showed a tendency for the efficacy of photodynamic therapy to increase (the rate of complete regression was 92.5%) compared with cryotherapy (85.0%) (p>0,05). There were also a tendency for long-term results after photodynamic therapy to improve: three-year recurrence-free survival was 94.6% and 88.2%, respectively. For the photodynamic therapy there were significantly fewer adverse reactions, the epithelization time in lesions was significantly shorter. Compared with cryotherapy the photodynamic therapy provided significantly better cosmetic results (p <0.01), and can be used for out-patient treatment of patients with actinic keratosis.><0.01) and can be used for out-patient treatment of patients with actinic keratosis.

Reliably established a causal role of human papillomavirus in the formation of condylomata acuminate. In 10% of people with the human papilloma virus develops condylomata acuminate, which can be transformed into malignant tumors. The most common treatment of condylomata acuminate is a conservative treatment, namely, the local chemical or physical destruction of the lesions and immunotherapy. With the ineffectiveness of conservative treatment resort to surgical excision. At the same time the traditional methods of treatment condylomata acuminate associated with high rates of recurrence. Moreover, these treatments are often associated with significant risk of bleeding, ulceration and scarring. The emergence of new methods of diagnosis and treatment of condylomata acuminate – fluorescence diagnosis and photodynamic therapy has opened up new opportunities to improve the treatment of this pathology. Topical administration of photosensitizers during photodynamic therapy is more convenient and less phototoxic and broaden the range of clinical applications of this technology in the medical dermatology. An increasing amount of evidence that photodynamic therapy with topical application of the photosensitizer is highly effective in the treatment of a variety of benign skin diseases, including condylomata acuminataca, for which traditional methods are ineffective treatment. However, many parameters of photodynamic therapy of this disease has not yet been optimized. It is necessary to conduct large-scale clinical studies on the effectiveness of photodynamic therapy of condylomata acuminatain order to standardize the treatment parameters.

Background: In basalioma, facial skin is frequent- E-mail: mmacosmetology@mail.ru ly affected. Thus, good cosmetological effect of treatment and anti-tumor efficacy are both important. Optimal approach includes prevention of pathological scarring. In many cases, preventive measures ensure normal scarring even after invasive methods of treatment. Aim: To assess efficacy and safety of Egallohit gel and its effects on scarring in patients with laser-induced thermotherapy (LITT) of basalioma. Materials and methods: 42 patients with superficial and micronodular basaliomas were included. LITT is a new highly effective and less invasive method providing satisfactory cosmetic results. Comprehensive treatment involved LITT (1 or 2 cycles) with subsequent application of Egallohit gel (up to 30 days after the intervention). Results: After the first LITT, clinical cure of basalioma was demonstrated in 41  (97.6%) patients. In one patient with superficial basalioma clinical cure was achieved after the second cycle of LITT. After epithelization of the tumor site, excellent and good clinical result was observed in 15 (35.7%) and 22 (52.5%) patients, respectively (satisfactory results were found only in 5 cases (11,8%), p<0,05). According to the Likert scale scores, 40  patients (95.2%) were very satisfied and 2  patients (4.8%) were satisfied with the treatment. Conclusion: Adding Egallohit after LITT in patients with basaliomas resulted in reduction of connective tissue growth in the lesions, promoted scar tissue resolution and surface smoothening (especially during scar formation), inhibited hyperemia and pigmentation and improved elasticity and displaceability of surrounding tissues.

Background: Localized scleroderma often results in irreversible cosmetic abnormalities and if advanced, to organ dysfunction and disability. Pharmacological treatment is not effective enough and can cause adverse events and complications. Due to this fact, much attention is paid to non-medical approaches to this disorder that would be able to exert positive clinical and patho-physiological effects and potentiate the effects of medical treatment. Aim: To evaluate the effects of local long-wave infrared irradiation on the course of localized scleroderma and to assess therapeutic efficacy of this method combined with conventional pharmacological treatment. Materials and methods: Fifty five (55) patients with localized scleroderma were included into the study. The patients from the control group (n = 20) were administered conventional medical treatment for 14 to 20 days, including antibacterials, proteolytic enzymes, calcium antagonists, antioxidants, topical vasculoprotectors + microcirculation correctors, as well as applications of corticosteroids. The patients from the main group (n = 35), in addition to conventional medical treatment, were administered local long-wave infrared irradiation of the lesions (wavelength 4 to 16 mcm, once daily for 10 days). We assessed changes in edema and hyperemia on the borders of the lesion, the degree and extent of the process with a modified scoring system mRODNAN Skin Score, as well as microcirculatory vasculature by means of Spectrotest. Results: Compared to the control group, the patients with localized scleroderma who, in addition to conventional medical treatment, were administered local long-wave infrared irradiation, showed a bigger reduction of mRODNAN index (2.2 ± 0.1 and 6.3 ± 0.5, respectively, р < 0.05), of oxygen saturation within the lesions (0.646 ± 0.04 and 0.9 ± 0.001 units, р < 0.05) and an increase of blood flow volume in the microcirculation (0.23 ± 0.045 and 0.091 ± 0.002 units, р < 0.05). They also demonstrated a quicker clinical improvement that was obvious at day 14 ± 2.3 (р < 0.05). In the control group, the clinical improvement was seen only at day 20 ± 4.2 (р < 0.05), with only a tendency towards a decrease in oxygen saturation within the lesions (from 0.87 ± 0.01 to 0.817 ± 0.005) and an increase of blood flow volume in the micro-circulation (from 0.086 ± 0.004 to 0.1 ± 0.003 units). The conventional medical treatment did not result in full resolution of the local scleroderma elements, this was confirmed by the results of assessment with mRODNAN index (mean value before treatment in this group was 6.4 ± 0.5, after treatment, 5.3 ± 0.2, р ≥ 0.05). Conclusion: The study proved the clinical efficacy of local long-wave infrared irradiation in the combination treatment of localized scleroderma. This effect was seen in the normalization of microcirculation parameters, increase of blood flow, decrease of oxygen saturation within the lesions reflecting active reparation, as well as in better clinical efficacy and more quick effect.

The paper presented results of photodynamic therapy for 139 patients with basal cell carcinoma. We conducted a study of the efficacy and safety of four methods of photodynamic therapy. There were used the following photosensitizers: photohem, photosens, photolon and photodithazine. Photodynamic therapy using photosensitizers of chlorine series (photolon and photoditazin) provides a better long-term results improving disease-free 3-year survival rate to 90.4% and 92.3%, respectively compared to 54.7% and 71.1% in groups, in which treatment was restricted by photohem and photosens.

The article reviews current data on the mechanisms of effects of laser radiation on the body, technical aspects of using different intensities of laser radiation and the effects of the laser on biological tissue. The results of studies of laser radiation as a part of comprehensive treatment of skin diseases including skin tumors are presented. Data on the efficacy and safety of laser therapy are discussed. Benefits of laser therapy in dermatology include shortening of treatment duration and only limited contraindications. Considering effectiveness, usability and safety of the method, it is regarded as a promising direction in dermatology.

Background: Photodynamic therapy is frequently applied for non-invasive destruction of basal cell carcinomas (BCC) of the skin; though, there is lack of evidence for efficacy of the method. Aim: To assess objective response of BCCs to photodynamic therapy with intralesional administration of photosensitizer Radachlorin in patients with different clinical forms, stages, flow patterns and localization of BCC. Materials and methods: 45 stage I–II BCCs patients with primary and recurrent solitary (ulcerative, superficial, scleroderma-like and nodular forms) and multiple lesions (predominantly Т₁– Т₂N₀M₀), with difficult to treat localization and high risk of recurrence were included during the period from March 2004 to March 2007. All patients received one cycle of photodynamic therapy with intralesional Radachlorin (0.5–1 ml/1 cm² tumor surface) and irradiation dose 300 J/cm² (wavelength 662 nm). A primary outcome measure was grade of clinical and cytological lesion regression after three months. Secondary outcome measure was stable clinical and cytological reaction at the lesion site. In the long-term, lesion recurrence was assessed yearly during 5 years. Results: Complete regression of BCCs was found in 43 (95.5%) patients and 47 (95.9%) lesions. In 2 (4.5%) patients with partial regression of 2 (4.1%) lesions repeated cycles of photodynamic therapy resulted in complete response. In BCCs Т₁N₀M₀, early outcome was independent from the clinical form of the diseases; by contrast, in BCCs Т₂N₀M₀, treatment of scleroderma-like BCCs was non-significantly less effective (66.7%) compared to nodular, surface (100% for both) and ulcerative (92.8%) forms. In the long-term, 1 tumor recurrence was observed after 29 months at the site of completely regressed ulcerative lesion. Conclusion: Photodynamic therapy with intralesional administration of photosensitizer Radachlorin is an effective treatment method for different clinical forms of BCC.

Background: In basalioma, facial skin is frequent- E-mail: mmacosmetology@mail.ru ly affected. Thus, good cosmetological effect of treatment and anti-tumor efficacy are both important. Optimal approach includes prevention of pathological scarring. In many cases, preventive measures ensure normal scarring even after invasive methods of treatment. Aim: To assess efficacy and safety of Egallohit gel and its effects on scarring in patients with laser-induced thermotherapy (LITT) of basalioma. Materials and methods: 42 patients with superficial and micronodular basaliomas were included. LITT is a new highly effective and less invasive method providing satisfactory cosmetic results. Comprehensive treatment involved LITT (1 or 2 cycles) with subsequent application of Egallohit gel (up to 30 days after the intervention). Results: After the first LITT, clinical cure of basalioma was demonstrated in 41 (97.6%) patients. In one patient with superficial basalioma clinical cure was achieved after the second cycle of LITT. After epithelization of the tumor site, excellent and good clinical result was observed in 15 (35.7%) and 22 (52.5%) patients, respectively (satisfactory results were found only in 5 cases (11,8%), p<0,05). According to the Likert scale scores, 40 patients (95.2%) were very satisfied and 2 patients (4.8%) were satisfied with the treatment. Conclusion: Adding Egallohit after LITT in patients with basaliomas resulted in reduction of connective tissue growth in the lesions, promoted scar tissue resolution and surface smoothening (especially during scar formation), inhibited hyperemia and pigmentation and improved elasticity and displaceability of surrounding tissues.

The review is on treatment of keratoacanthomas using photodynamic therapy. The defining characteristic of keratoacanthoma among epithelial tumors is a rapid spontaneous regression in the case of typical keratoacanthoma and long-term persistence, recurrence and common malignant transformation to squamous cell carcinoma in the case of atypical keratoacanthoma. In recent years, photodynamic therapy which is an effective method of treatment of different types of cancer and pre-cancer diseases of the skin including actinic keratosis, Bowen’s disease, basal cell carcinoma, is increasingly used in clinical practice. There are few data for photodynamic therapy in the treatment of keratoacanthoma. The analysis of the literature shows that using of photodynamic therapy in the set of treatment modalities in patients with keratoacanthoma improves the efficacy and reduces the terms of the therapy. In all investigations except one there was complete tumor regression in 100% patients with keratoacanthoma who underwent photodynamic therapy. In one study complete tumor regression was observed in 66.7% of patients with atypical keratoacanthoma after photodynamic therapy. The follow-up of patients in all analyzed studies accounted for at least 2-3 years. During this time none of the patients had evidence for recurrence. This approach has minimal restrictions for application. Thus, photodynamic therapy may become a therapeutic alternative to surgical treatment of keratoacanthoma with good clinical and cosmetic results.

The review is on treatment of keratoacanthomas using photodynamic therapy. The defining characteristic of keratoacanthoma among epithelial tumors is a rapid spontaneous regression in the case of typical keratoacanthoma and long-term persistence, recurrence and common malignant transformation to squamous cell carcinoma in the case of atypical keratoacanthoma. In recent years, photodynamic therapy which is an effective method of treatment of different types of cancer and pre-cancer diseases of the skin including actinic keratosis, Bowen’s disease, basal cell carcinoma, is increasingly used in clinical practice. There are few data for photodynamic therapy in the treatment of keratoacanthoma. The analysis of the literature shows that using of photodynamic therapy in the set of treatment modalities in patients with keratoacanthoma improves the efficacy and reduces the terms of the therapy. In all investigations except one there was complete tumor regression in 100% patients with keratoacanthoma who underwent photodynamic therapy. In one study complete tumor regression was observed in 66.7% of patients with atypical keratoacanthoma after photodynamic therapy. The follow-up of patients in all analyzed studies accounted for at least 2-3 years. During this time none of the patients had evidence for recurrence. This approach has minimal restrictions for application. Thus, photodynamic therapy may become a therapeutic alternative to surgical treatment of keratoacanthoma with good clinical and cosmetic results.

Reliably established a causal role of human papillomavirus in the formation of condylomata acuminate. In 10% of people with the human papilloma virus develops condylomata acuminate, which can be transformed into malignant tumors. The most common treatment of condylomata acuminate is a conservative treatment, namely, the local chemical or physical destruction of the lesions and immunotherapy. With the ineffectiveness of conservative treatment resort to surgical excision. At the same time the traditional methods of treatment condylomata acuminate associated with high rates of recurrence. Moreover, these treatments are often associated with significant risk of bleeding, ulceration and scarring. The emergence of new methods of diagnosis and treatment of condylomata acuminate – fluorescence diagnosis and photodynamic therapy has opened up new opportunities to improve the treatment of this pathology. Topical administration of photosensitizers during photodynamic therapy is more convenient and less phototoxic and broaden the range of clinical applications of this technology in the medical dermatology. An increasing amount of evidence that photodynamic therapy with topical application of the photosensitizer is highly effective in the treatment of a variety of benign skin diseases, including condylomata acuminataca, for which traditional methods are ineffective treatment. However, many parameters of photodynamic therapy of this disease has not yet been optimized. It is necessary to conduct large-scale clinical studies on the effectiveness of photodynamic therapy of condylomata acuminatain order to standardize the treatment parameters.

Background: Photodynamic therapy (PDT) has shown its clinical efcacy in the treatment of keratoacanthoma. However, the published data is scarce and contradictory. Methods of a photosensitizer administration and irradiation doses depending on the type of keratoacanthoma have not been defned. Aim: To develop the diferentiated approached to PDT for typical and atypical keratoacanthoma by variation of the light density while using of a chlorine photosensitizer. Materials and methods: We assessed and treated 36 patients with cytologically and/or histologically confrmed solitary keratoacanthomas, among them 22 patients with typical and 14 patients with atypical ones. In 12 patients, persistent keratoacanthomas were diagnosed, in 1, a gigantic one and in 1, a centripetal one. Each patient was administered one session of PDT with an intralesional administration of a photosensitizer Radachlorin at a dose of 0.75 mL/cm3. The source of laser irradiation was a medical laser device LAMI (with the wave- length of 662 ± 3 nm, the power of irradiation at the edge of the light guide, 2 Wt). The absorbed light density was 50 J/cm2 for typical keratoacanthomas and 300 J/cm2 for atypical ones. 70 Results: After the treatment, in 32 (89%) of patients the tumor completely regressed within one month (26 ± 1.3 days). In 4 patients (all with atypical keratoacanthomas) the tumors did not regress within one month and was removed surgically with the 3 mm margins of obviously normal skin. At the site of former tumors, there were areas of atrophic scarring (26 cases, in 4 patients, with hyperpigmentation) or with normotrophic scarring (10 patients) that were cosmetically acceptable. Within the next 2 years of the follow-up no relapses were observed. Conclusion: Thus, we proposed an efective method of diferentiated approach to PDT of typical and atypical keratoacanthomas based on one PDT session with an intralesional administration of Radachlorin at a dose of 0.75 mg/cm3 of the tumor, with the intensity of irradiation of 0.39 Wt/cm2. The light dose density for typical keratoacanthomas is 50 J/cm2 and for atypical ones, 300 J/cm2.

The new method of photodynamic therapy for basal cell skin carcinoma with intralesional injection of photolon (at dose of 1.44-2.50 mg/cm3 of tumor volume 15 min before irradiation) was developed in the department of dermatology, venerology and dermatooncology in The State Budgetary Healthcare Institution of Moscow Area Moscows regional research clinical institute n.a. M.F. Vladimirskiy. The efficacy of the developed method was evaluated in clinical studies in 30 patients comparing with the group of 32 patients who had conventional PDT with typical intravenous injection of photolon (at dose of 2.0–2.5 mg/kg of body weight 3 h before irradiation). The characteristics of irradiation were the same both in the study and in the control groups: power density of 0.31-0.47 W/cm2, light dose of 300 J/cm2. Compared PDT regimens had similar efficiency. As a result of the performed treatment complete tumor regression was achieved in 93.3% patients with intralesional injection of photolon and in 90.6% patients with intravenous injection. The rate of patients with 2-year recurrence-free survival after intralesional injection of photolon accounted for 96.7%; after intravenous injection – 93.8%. However, the developed method demonstrated superior safety comparing with intravenous injection of photolon: such as there was no need for light regimen after intralesional injection of photolon, there were no cases of skin phototoxicity (12.5% for intravenous injection), no increasing of transaminases (37.5% for intravenous injection).

The Department of Dermatology and Venereology and Dermatooncology of M.F. Vladimirskiy MRRCI and the Department of Photodynamic diagnosis and therapy of A. Tsyb MRRC developed a new technique of photodynamic therapy for basal cell carcinoma with local application of chlorine series Photolon. Photodynamic therapy with the local use of this drug has shown to be highly effective in the treatment of all clinical forms of the disease. Photodynamic therapy techniques basal cell carcinoma using local and intravenous photosensitizer comparable with each other. Our results have shown that photodynamic therapy using a photosensitizer local has significant advantages. The method is inexpensive and effective treatment with good cosmetic result, does not require compliance with the light regime, has no side effects and complications, can be used without restriction of age and the presence of comorbidities, the treatment of choice in patients with severe somatic pathology in patients older age group, can be used for disease recurrence repeated many times. PDT is preferably carried out in an outpatient setting.

It was performed the analysis of modern approaches to the treatment of Kaposi's sarcoma based on the disease pathogenesis understanding. It indicated that the standard pattern of therapy should be selected depending on the type and stage of disease, and patient’s immune status. Along with local and systemic treatment with various drugs used methods aimed at the destruction of local lesions: electron radiation, radiotherapy, gamma-therapy. Considered reports on the effectiveness of photodynamic therapy, extracorporeal photochemotherapy, laser therapy in the treatment of Kaposi's sarcoma. Attention is drawn to the possibility of using laser-induced thermotherapy, the effect of which is based on the possibility of establishing a local hyperthermia. In the absence of information on the effectiveness of this method in the Kaposi's sarcoma treatment it concluded that further studies in this direction.